运用二维斑点追踪技术评估长新冠综合征患者早期亚临床心肌损害的研究
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南京医科大学第一附属医院心血管内科

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国家自然科学基金(81901416); 江苏省自然科学基金(BK20191067)


Quantitative evaluation of subclinical myocardial damage in patients after COVID-19 infection by two-dimensional speckle tracking imaging
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    摘要:

    目的:应用二维斑点追踪技术评价长新冠患者早期亚临床心肌损害的应用价值。方法:在门诊连续入组2022年12月07日我国新冠疫情解封后新冠感染后患者59例作为观察组,选取新冠流行前门诊患者60例作为对照组,收集患者基本临床资料及心肌损伤标志物等化验指标,采用二维心超及二维斑点追踪技术(Two-Dimensional Speckle Tracking Imaging,2D-STI)评估患者左室射血分数(Left Ventricular Ejection Fraction,LVEF)、左室舒张功能E/A、E/e’,左心室整体纵向应变(Global Longitudinal Strain,GLS)及十八节段应变值,计算并比较各组间心率、LVEF、E/A、E/e’、GLS及十八节段应变值。结果:研究发现长新冠综合征患者的左室舒张功能E/A(1.14±0.34 vs 1.46±0.44, P<0.001)、E/e’(8.01±2.08 vs 7.21±1.53,P<0.05)及左室整体纵向应变GLS(-20.57%±2.15% vs -21.90%±1.73%, P<0.001)较未感染者显著下降。进一步行十八节段应变分析发现新冠组患者主要表现为前间隔基底部、前壁中间部、前间隔中间部、下侧壁中间部、前侧壁中间部、前壁心尖部、前间隔心尖部、下壁心尖部、下侧壁心尖部和前侧壁心尖部等十个节段的显著降低(P<0.05)。通过感染后时间的亚组分析发现,随着新冠康复时间延长,患者GLS呈现逐渐改善趋势。结论:新冠后患者常出现左室舒张功能及GLS的下降。而随着新冠康复时间的延长,上述指标呈现逐渐改善趋势。应用2D-STI可以定量评估长新冠患者早期亚临床心肌损害,可能为新冠患者的临床诊治提供一定的证据。

    Abstract:

    Objective Quantitative evaluation of early subclinical myocardial damage in patients with COVID-19 infection by two-dimensional speckle tracking imaging(2D-STI). Methods A total of 59 patients with post-COVID-19 infection after the COVID-19 outbreak was lifted in China on December 7, 2022 were continuously enrolled as the observation group, and 60 outpatients before COVID-19 epidemic were selected as the control group. Basic clinical data and markers of myocardial injury and other laboratory indicators of patients were collected. Left ventricular ejection fraction, left ventricular diastolic function, left ventricular global longitudinal strain (GLS) and 18-segment strain values were evaluated by two-dimensional echocardiography and 2D-STI. Heart rate, LVEF, E/A, GLS and 18-segment strain values were calculated and compared among all groups. Results We found that most patients after COVID-19 infection showed non-myocarditis characteristics, mainly manifesting cardiovascular discomfort such as chest tightness, chest pain and palpitation. Further studies showed that left ventricular diastolic function and GLS were significantly decreased in patients after COVID-19 infection compared with those without infection, while left ventricular systolic function was not significantly different. Eighteen segment strain analysis showed that in the COVID-19 group, 10 segments, including basal anteroseptal, mid anterior, mid anteroseptal, mid inferolateral, mid anterolateral, apical anterior, apical anteroseptal, apical inferior, apical inferolateral and apical anterolateral were significantly reduced. Subgroup analysis of post-infection time showed that the GLS of patients showed a gradual improvement trend with the extension of COVID-19 recovery time. Conclusions Most patients with COVID-19 infection have non-myocarditis features, mainly showing cardiovascular discomfort such as chest tightness, chest pain and palpitations. After COVID-19, left ventricular diastolic function and GLS were decreased, and the absolute value of strain was significantly decreased mainly in the left ventricular apex. The patients' heart function and GLS gradually improved with the prolonged recovery time of COVID-19. The application of 2D-STI technique can quantitatively evaluate early subclinical myocardial damage in patients with long novel coronavirus syndrome, and probably provide data support and guidance for clinical diagnosis and treatment of novel coronavirus patients.

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  • 收稿日期:2023-07-30
  • 最后修改日期:2023-11-12
  • 录用日期:2023-11-27
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